| 1 BackgroundRadiotherapy(Radiotherapy,RT)referred to as radiation therapy,is the treatment of breast cancer,esophageal cancer,lung cancer and me detail 1 tumor,thymus gland tumor metastases and chest,etc.One of the commonly used method,its curative effect is dose-effect relationship,namely the complications are increased with the increase of local treatment effect.Lung tissue is a sensitive organ in Radiation,so when receiving chest radiotherapy,normal lung tissue is easily involved and radiation-induced lung injury(RILI)occurs.RILI is mainly divided into two stages:the early radiation-induced lung inflammation of the lungs(RILP)and the late radiation-induced lung fibrosis(RPF)The irreversible radiation-induced lung fibrosis is often critical or even life-threatening.Currently,there is no standard and effective treatment for radioactive lung injury,and most of them are mainly based on empirical treatment,among which glucose and hormone are commonly used as the basic drugs,and are often used in combination with sputum dissolving drugs,bro n ch o dilators and antibiotics.The pharmacological mechanism of glucose and hormone is to reduce pulmonary exudation and pulmonary edema,to relieve the damage degree of lung cells and Micro-pulse tube,and to effectively control clinical symptoms.In the process of use,attention should be paid to glucose and hormone induced hyperglycemia,hypertension,double infection,gastrointestinal bleeding and drug withdrawal syndrome and other adverse reactions,and the hormone has little effect on the stage of radioactive pulmonary fibrosis.Therefore,finding an active and effective treatment scheme for radioactive lung injury to appropriately improve the patient’s tolerance to radiation and the quality of life has attracted much attention and become one of the problems that need to be solved urgently.Interleukin-17a(IL-17A)is a recently discovered inflammatory factor,mainly secreted by helper T cell 17(Th17).Experimental studies have confirmed that inhibiting the expression of IL-17A can effectively reduce the severity of radioactive pneumonia and improve radioactive pulmonary fibrosis.Some scholars have confirmed that the expression of IL-17A in the peripheral blood of rats with radioactive lung injury is significantly increased,which plays an important role in the occurrence and development of radioactive pneumonia.In recent years,it has been found that traditional Chinese medicine has achieved considerable curative effect in the prevention and treatment of radioactive pneumonia.There is no record of the disease name of radioactive pneumonia in the medical works of the motherland,and the discussion on its pathogenesis and treatment is also in the stage of "hundred schools of thought contend".By summarizing its pathological factors,it can be summarized into seven types:heat toxicity,Yin deficiency,blood stasis,and deficiency.In this study,the syndrome distribution characteristics of patients with radioactive pneumonia were firstly discussed through clinical observation.Secondly,the peripheral blood and local lung tissues of RILP model rats were taken as the research object,and the efficacy and mechanism of director hot words empirical prescription " Nourishing Yin and Detoxifying Lung" was explored with the to kine IL-17A as the focus.This study is mainly divided into three parts.The first part is the experimental study,which summarizes the research status of radiation pneumonia in Chinese and western medicine.Radiation pneumonia is one of the common complications after chest radiotherapy,which has not yet formed a clear and unified pathogenesis.Currently,there are widely recognized theories such as "to kine cascade" theory,dative stress injury theory,and immune response theory.There is no record of the name of radioactive pneumonia in traditional Chinese medicine,according to its four diagnosis information,it will be more "cough","asthma","lung dysfunction" and other categories.Scholars of traditional Chinese medicine have not formed a unified understanding of its occurrence and development,and they usually treat it by stages or by type according to the clinical experience and the characteristics of patients,and obtain certain curative effects.IL-17A is a newly discovered inflammatory to kine related to RILP,so this study will explore the mechanism of TCM intervention on RILP from the perspective of IL-17A.The second part is clinical observation.Through the collection of the four diagnosis information of 108 cases of radioactive pneumonia,the data were input into the computer,the database was established by using EXCEL 2010,and the data were processed to explore the syndrome distribution characteristics of radioactive pneumonia.The results showed that the TCM syndrome differentiation of RILP patients mainly focused on the syndrome of lung injury caused by heat toxicity and the syndrome of deficiency of qi and Yin,so the treatment methods should focus on clearing heat and detoxification,invigorating qi and nourishing YinThis may be associated with the strong energy and penetration of the radiation itself;As well as the lung is petite dirty,not resistant to cold and heat and other factors.The third part is an experimental study.By constructing a RILP rat model,using the formula of "Nourishing Yin and Detoxifying Lung",using pathology,enzyme-linked immunity assay(ELISA),fluorescence in situ hybridization(FISH)and other research methods,the general condition,pathological morphology and expression of IL-17A in tissues and peripheral blood of RILP rats were observed.The results showed that Nourishing Yin and Detoxifying Lung could effectively improve the severity of radioactive pneumonia in rats,and the mechanism of action might be related to the down-regulation of IL-17A expressionIt is suggested that the prescription of Nourishing Yin and Detoxifying Lung can prevent and cure radiation pneumonia by interfering the expression of IL-17A under the guidance of clearing heat and detoxification and nourishing Yin and run drynessIn conclusion,the author discussed the syndrome distribution characteristics of radioactive pneumonia and the prevention and treatment of RILP by Nourishing Yin and Detoxifying Lung prescription from three aspects of literature retrieval,clinical observation and animal experiments,and inaugural clarified that the intervention mechanism may be related to the expression of IL-17A.The results of this study provide theoretical basis and research ideas for summarizing the syndrome characteristics of radioactive pneumonia and the prevention and treatment of radioactive pneumonia by traditional Chinese medicine.2.Object(1)by observing the symptoms,tongue,pulse and other information of 108 cases of RILP patients,the characteristics of radioactive pneumonia were discussed through data processing to provide theoretical basis for clinical medication.(2)by observing the general condition,lung pathological morphology,lung coefficient,and expression of IL-17A in peripheral blood and local lung tissues of rats with radioactive pneumonia treated by Nourishing Yin and Detoxifying Lung prescription,the therapeutic effect of this prescription on radioactive pneumonia and its relationship with the expression of IL-17A were discussed to provide ideas for future research.3 Methods3.1 clinical study on TCM syndrome distribution of radioactive pneumonia3.1.1 survey methodsIn January 2018 to December 2019 in our hospital clinic of radioactive lung injury in patients with cross-sectional survey,due to the investigation of information are mostly from the respondent’s own feelings,therefore the questionnaire is given priority to with the fill type,in order to ensure to get more objective data information,part CRF form filled out by investigating medical,combined with patient to fill out the questionnaire results,all relevant knowledge instruction to patientsThe questionnaire was collected and entered into the database in time,the TCM syndromes and clinical indicators were sorted out,and the data were statistically analyzed.3.1.2 Analysis methodsAll the questionnaire data were recorded in the way of double entry,and the collected data were analyzed and processed after being proved to be correct.Descriptive statistical analysis:qualitative indicators were described by frequency,percentage or composition ratio,while quantitative indicators were described by mean and standard deviation.The counting data conforming to the normal distribution were tested by x2 test,the measurement data were tested by t test,and the rank sum test was used for the measurement data not conforming to the normal distribution.3.2 experimental study on the intervention of Nourishing Yin and Detoxifying Lung prescription in radioactive pneumonia(1)single irradiation of 16Gy in the irradiation group was used to construct the model of radioactive pneumonia in rats,while the normal group was used to simulate pulmonary radiation of OGy under the same conditions.(2)each group began Lick-feeding administration on the 1 st day after irradiation,1/day,lasting 28 days,and the administration was adjusted weekly according to the weight change.(3)sampling was conducted after 28 days of irradiation,and the general survival condition of the rats and local lung tissues were observed pathologically.The contents of IL-17A in peripheral blood and alveolar lavage fluid were determined by enzyme-linked immunity assay(ELISA).The expression of IL-17Amrna in lung tissues was detected by fluorescence in situ hybridization(FISH)4 Results4.1 clinical observation and study resultsAmong the 108 cases of radiation pneumonia,the most common type of radiation pneumonia was heat poisoning to the lung,in 39 cases(36.11%of the total number of patients),followed by qi and Yin deficiency syndrome in 28 cases(25.93 of the total number of patients).4.2 results of animal experimentsThe degree of lung injury was more obvious in the model group 28 days after exposure,and the score was 3 points,which was significantly different from that of the normal group(P<0.001).The difference between the treatment group and the model group was significant,and the Small cannon inflammation score in the TCM+hormone group decreased the most,with the most significant difference(P<0.01).There was no significant difference in Small cannon inflammation scores between each group and the control group(P>0.05).The local expression of IL-17Amma in the lung tissues of rats was detected by fluorescence in situ hybridization,and the expression of IL-17A MRNA was highly expressed in the model group(M group)and low in the normal control group(C group).The significant difference between the two groups indicated that the modeling was successful,and the expression level of each drug group was between the model group and the traditional Chinese medicine group.Firstly,localization experiments were conducted to demonstrate the local high expression of IL-17A in the lung tissues of radioactive pneumonia rats.Secondly,it was shown that the three drug intervention methods could significantly reduce the expression of IL-17A.Further quantitative detection by ELISA showed that compared with the normal group,the expression level of IL-17A in alveolar lavage fluid of rats in the irradiation group was significantly increased,especially in the model group,and the difference was significant(P<0.05).IL-17A in peripheral blood of rats also conforms to the sub trend.5 conclusionsRadioactive pneumonia in patients with clinical syndrome mainly concentrated in the hot poison damage lung syndrome and Yin deficiency syndrome,in terms of heat-clearing and detoxify,nourishing Yin moistening lung to under the guidance of the therapeutic principle of nourishing Yin clearing lung detoxification,can improve RILP inflammation of rat lung tissue level,its mechanism may be related to cut IL-17 a expression,show that the can by adjusting the IL-17 a fall prevention effect to the radioactive pneumonia. |
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